OPPORTUNITIES 

IN  THE 

FIELD  OF  NURSING 

BY 

ISABEL  MAITLAND  STEWART,  R.N.,  A.M. 

Assistant  Professor,  Department  of  Nursing 
and  Health,  Teachers  College,  Columbia 
University,  Nem  York  City 


Published  by 

The  Committee  on  Nursing 
of  the  Council  of  National  Defense 
,  By  permission 

of  the  Nursing  and  Health  Branch  of  the 
Alumni  Association,  Teachers  College 
Columbia  University 
City  of  New  York 
1917 

This  pamphlet  is  in  its  2Sth  thousand  and  this  edition 
brings  it  up  to  the  3Sth  thousand 


PREFACE 


There  probably  never  was  a  time  when  so  many 
young  women  were  so  sincerely  anxious  to  make  their 
life-work  count  for  something  worth  while.  The 
thoughtful  girl  or  woman  is  not  satisfied  any  more  with 
simply  an  easy  job,  or  a  situation  that  brings  in  an 
immediate  money  return.  She  wants  something  that 
will  stir  her  interests,  that  will  develop  her  latent  ability, 
and  will  give  her  a  chance  to  contribute  something  to 
the  real  work  of  the  world. 

This  is  particularly  true  since  the  war  has  brought 
home  to  us  so  forcibly  the  need  for  utilizing  every 
available  talent  and  all  the  energy  and  devotion  we 
possess  in  some  definite,  productive,  form  of  national 
service.  Nursing  is  probably  the  most  vital  and  satis¬ 
fying  form  of  service  which  any  woman  can  render  in 
critical  times  such  as  these,  and  it  will  be  just  as  much 
needed  in  the  period  of  reconstruction  that  will  come 
after  the  war. 

The  purpose  of  this  pamphlet  is  to  give  all  the  main 
facts  about  the  profession  as  clearly  and  impartially  as 
possible,  and  to  advise  those  who  intend  to  fit  them¬ 
selves  for  this  work  how  best  to  proceed.  Those  who 
are  engaged  in  the  nursing  profession  and  know  it  most 
intimately,  do  not  hesitate  to  commend  it  to  your  serious 
consideration,  believing  that  in  breadth  and  variety  of 
opportunity,  in  possibilities  of  service,  and  in  positive 
human  interests,  no  profession  of  the  present  day  offers 
larger  returns  to  the  educated  woman. 


Opportunities  in  the  Field  of 
Nursing 


Development  of  the  Profession 

The  story  of  the  birth  of  our  modern  pro¬ 
fession  of  nursing  reads  more  like  a  romance 
than  a  history.  Everybody  is  familiar  with  the 
picture  of  the  crowded  hospital  barracks  of  the 
Crimea,  the  lack  of  proper  food  and  proper  care, 
the  dreadful  harvest  of  death  from  wounds  and 
cholera  —  then  the  change  that  came  with  the 
arrival  of  Florence  Nightingale  and  her  little 
band  of  nurses,  when  the  “  charnel-house  of 
misery  ”  became  a  decent,  safe,  well-managed 
home  for  sick  people. 

The  spectacular  reduction  in  the  death  rate, 
which  went  down  from  between  thirty  and  fifty 
to  about  two  percent,  was  not  the  only  proof  of 
the  value  of  intelligent  and  skillful  nursing. 
Those  refined  and  capable  women  had  brought 
with  them  a  new  atmosphere,  a  new  sense  of  com¬ 
fort  and  security,  a  new  measure  of  efficiency  in 
the  management  of  such  institutions,  that  broke 
down  at  last  all  the  unreasoning  and  bitter  oppo¬ 
sition  which  had  met  them  in  the  beginning  of 
their  work.  The  rough  hospital  orderly,  the  poor 
old  incompetent  drudge,  and  the  devoted  but  un¬ 
skilled  amateur  were  alike  relegated  to  the  past, 


4 


so  far  as  the  expert  care  of  sick  people  was  con¬ 
cerned.  The  “  trained  ”  nurse  had  arrived. 

From  the  very  beginning  Florence  Nightin¬ 
gale  insisted  on  training  as  the  only  means  of 
reaching  proficiency  in  nursing.  She  had  abso¬ 
lutely  no  patience  with  the  “  born-nurse  ”  theory, 
nor  with  the  ordinary  pottering  and  fussing 
about  sick-beds  which  well-intentioned  and  ami¬ 
able  women  dignified  by  the  name  of  “  nursing.” 
To  all  the  ardent  and  sometimes  sentimental 
young  women  who  began  to  volunteer  their  ser¬ 
vices  for  the  care  of  the  sick,  she  emphasized  the 
absolute  necessity  of  long,  rigorous  training. 
“  Nursing  is  an  art,”  she  insists,  “  and  if  it  is  to  be 
made  an  art  it  requires  as  hard  a  preparation  as 
any  painter’s  or  sculptor’s  work;  for  what  is 
having  to  do  with  dead  canvas  or  cold  marble 
compared  with  having  to  do  with  the  living 
body  ?  ”  Again  she  calls  it  “  the  finest  of  the  fine 
arts.” 

As  a  public  testimonial  to  the  services  of  this 
great  woman,  the  first  nursing  school  was  estab¬ 
lished  in  connection  with  St.  Thomas’  Hospital, 
London,  and  from  that  time  to  the  present, 
schools  have  multiplied  at  a  very  rapid  rate. 
There  are  at  the  present  time  in  America  approxi¬ 
mately  1,500  schools  of  nursing,  with  a  student 


5 


body  of  about  40,000.  This  is  a  larger  number  of 
students  than  will  be  found  in  all  the  medical  col¬ 
leges  of  the  country,  and  exceeds  the  number 
of  women  students  now  registered  in  all  Ameri¬ 
can  colleges. 

The  work  has  attracted  on  the  whole,  an 
exceptional  body  of  women,  who  have  built  about 
it  the  most  splendid  traditions  of  personal  and 
public  service.  Though  one  of  the  youngest  of 
the  professions,  it  has  already  a  strong  organi¬ 
zation,  with  rapidly  advancing  professional 
standards  and  a  considerable  literature. 

Scope  of  the  Field 

From  two  or  three  original  branches,  the 
work  has  broadened  out  till  there  are  now  from 
twenty  to  thirty  fairly  distinct  lines  of  activity. 
From  the  rather  limited  field  of  the  hospital 
and  home,  the  nurse  now  goes  out  into  streets 
and  tenements,  into  shops  and  factories,  into 
schools  and  colleges.  From  the  more  or  less 
simple  personal  services  to  the  sick,  her  work  has 
developed  till  it  includes  a  large  number  of 
important  duties,  some  of  them  distinctively  med¬ 
ical  and  sanitary,  others  educational  and  adminis¬ 
trative  and  others  public  and  social  in  character. 
So  rapid  has  been  the  expansion  of  this  field  that 
there  has  never  been  an  adequate  number  of  qual- 


6 


ified  nurses  to  meet  the  need.  There  are  probably 
over  100,000  nurses  practising  in  the  United 
States  at  the  present  time,  and  yet  the  demand  for 
competent  nurses  still  far  exceeds  the  supply. 

All  the  indications  go  to  prove  that  this 
demand  will  be  substantially  increased  in  the 
immediate  future.  Those  who  have  been  gauging 
the  tendencies  of  the  past  few  years  say  that  not 
hundreds  more,  but  thousands  will  very  soon  be 
needed,  not  only  in  homes,  hospitals,  and  public 
schools,  but  as  workers  on  boards  of  health,  in 
philanthropic  societies,  in  systems  of  education, 
in  factories  and  department  stores,  in  rural  dis¬ 
tricts,  and  wherever  this  new  idea  of  health  con¬ 
servation  is  being  actively  worked  out.  The  war 
has  brought  a  greatly  increased  demand  for 
nurses,  not  only  for  the  care  of  the  sick  and 
wounded  abroad,  but  also  for  the  care  of  the 
sicks  in  camps  and  for  the  protection  of  workers 
in  munition  factories  and  other  industries.  It  is 
imperative  that  the  present  forces  should  be  sub¬ 
stantially  increased  in  the  near  future.  The  scope 
of  the  work  is  at  present  practically  unlimited, 
and  the  promise  of  really  live,  interesting,  and 
useful  employment  is  assured  to  all  who  are 
personally  qualified  and  who  fit  themselves  ade¬ 
quately  for  it. 


7 


Purpose  and  Character  of  Nursing  Work 

The  word  “  nursing  ”  is  a  beautiful  old  word, 
meaning  “  to  nourish,”  “  to  tend,”  “  to  sustain  or 
protect.”  The  impulse  to  care  for  those  who  are 
helpless  and  ailing  comes  from  the  deeply-rooted 
mother-instinct  which  all  true  women  have  in 
some  degree.  A  recent  author  calls  the  nurse 
the  “  foster-mother  ”  of  the  race.  “  Wherever 
and  whenever  there  is  life  to  be  tended,  nourished 
or  nursed,  educated  and  saved,  whether  the  life 
be  yet  unborn  or  new-born  or  senile  or  ill,  there 
is  the  field  for  womanhood  exercising  its  great 
function  of  foster-motherhood.” 

In  a  general  way,  the  nurse  in  the  hospital 
or  home  is  responsible  for  the  personal  care  of  the 
sick  person.  She  provides  the  right  mental  and 
physical  environment  for  the  patient,  prevents  the 
spreading  of  disease  to  others,  carries  out  the 
physician’s  instruction  regarding  diet,  medicines, 
etc.,  assists  him  in  operations  and  treatments, 
observes  and  notifies  the  physician  of  all  impor¬ 
tant  developments  in  the  condition  of  the  patient, 
and,  where  consultation  is  impossible,  administers 
the  proper  medical  measures  as  necessity  arises. 
The  nursing  staff  in  the  hospital  is  also  respon¬ 
sible  for  organizing  and  administering  the  various 
services  connected  with  the  care  of  the  sick  in  the 


8 


most  efficient  and  economical  manner  possible. 

In  some  of  the  other  branches  of  the  work 
the  nurse  is  employed  mainly  in  anticipating  ill¬ 
ness  by  identifying  the  early  signs  of  trouble,  in 
investigating  unsanitary  conditions,  and  teaching 
people  how  to  prevent  ill-health.  In  all  these 
branches  the  nurse  is  expected  to  be  familiar  with 
and  codperate  with  all  the  other  agencies  which 
are  working  toward  the  relief  of  suffering  and 
the  prevention  of  disease. 

It  will  be  seen  from  this,  that  the  nurse  is  not 
merely  the  assistant  of  the  physician,  though  this 
itself  is  an  important  and  very  responsible  func¬ 
tion.  The  nursing  art  is  just  as  distinct  and  as 
specialized  as  the  art  of  the  medical  practitioner, 
and  is  more  and  more  recognized  as  such.  Some¬ 
times  it  is  the  skill  of  the  surgeon  or  physician 
that  turns  the  scale  in  favor  of  recovery,  and 
sometimes  it  is  good  nursing  —  one  supplements 
the  other,  and  both  are  usually  necessary  in  any 
adequate  care  of  sick  people. 

With  the  increased  emphasis  which  is  being 
put  on  fresh  air,  good  food,  exercise,  mental 
influences  and  occupation  in  the  treatment  of  dis¬ 
ease,  more  and  more  responsibility  is  put  upon  the 
nurse,  and  a  much  higher  degree  of  initiative  and 
judgment  is  demanded  of  her.  In  many  of  the 


9 


newer  branches  of  the  profession  the  nurse  works 
more  or  less  independently,  calling  in  the  services 
of  the  medical  expert  only  when  necessary.  Her 
duties  are  perhaps  more  distinctly  social  and  edu¬ 
cational  than  medical,  and  yet  she  must  under¬ 
stand  the  nature  and  causes  of  disease,  and  must 
be  expert  in  the  observation  and  handling  of  sick 
people. 

Training  Required  and  How  Secured 

It  will  be  seen  at  once  that  such  duties  and 
responsibilities  demand  a  very  considerable  degree 
of  knowledge  and  skill.  The  sciences  underlying 
them  are  varied  and  comprehensive,  the  proced¬ 
ures  are  often  complicated  and  technical,  and  the 
power  of  observation  required  is  highly  special¬ 
ized.  The  ability  to  organize  all  these  complex 
duties,  to  deal  with  all  classes  and  kinds  of  people, 
and  to  meet  critical  situations  wisely  and  prompt¬ 
ly,  requires  long  experience  and  constant  practise 
in  the  actual  conditions  of  the  sick-room.  From 
lectures  and  text-books  alone,  important  and 
essential  as  these  are  in  certain  phases  of  the 
training,  such  powers  cannot  be  derived. 

These  are  some  of  the  reasons  why  schools 
of  nursing  must  be  attached  to  hospitals,  and  why 
from  two  to  three  years’  experience  in  the  actual 


10 


handling  and  care  of  sick  people,  under  the  con¬ 
stant  eye  of  experts,  is  considered  essential  to 
ensure  safety  to  the  public  and  an  adequate  train¬ 
ing  to  the  nurse. 

Types  of  Schools. 

Nursing  schools  are  connected  with  general 
hospitals,  (caring  usually  for  all  types  of  diseases 
and  all  classes  of  patients)  and  special  hospitals, 
such  as  fever,  maternity,  surgical,  tubercular,  and 
insane  hospitals,  or  hospitals  for  children,  for 
women,  etc. 

Generally  speaking,  the  hospital  caring  for  a 
wide  range  of  diseases,  with  patients  of  every  age, 
class  and  sex  represented,  and  with  a  pretty  active 
service,  offers  the  best  facilities  for  training.  It 
is  absolutely  essential  that  the  student  nurse 
should  have  adequate  experience  in  the  care  of 
medical,  surgical  and  obstetrical  cases,  and  in  the 
diseases  of  children. 

Hospitals  vary  much  in  size,  ranging  from  15 
or  25  beds  up  to  1,000  or  1,500,  or  even  more. 
New  York  State  and  several  other  states  require 
any  school  which  is  registered  as  a  training  school 
for  nurses  to  be  connected  with  a  hospital  of  at 
least  50  beds.  The  small  private  or  the  special 
hospital  is  at  a  distinct  disadvantage  in  offering  a 


II 


training  for  nursing,  unless  it  is  affiliated  with 
other  hospitals  giving  experience  in  all  branches 
of  nursing  work. 

Length  of  Training. 

With  the  developments  in  surgery  and  medi¬ 
cine  creating  a  large  number  of  new  specialties 
and  with  the  gradual  extension  of  the  nurse’s 
duties,  the  course  of  training  has  been  extended 
from  one  to  two,  and  later,  in  most  of  the  best 
schools,  to  three  years.  It  is  found  that  the  work 
cannot  be  covered  thoroughly,  and  that  the  aver¬ 
age  student  nurse  cannot  get  the  maximum  benefit 
from  her  course  in  less  than  three  years. 

Several  prominent  hospitals  have  recently 
agreed  to  reduce  the  regular  three-year  course  by 
from  eight  to  twelve  months,  for  students  who 
have  completed  a  full  college  training,  including 
satisfactory  courses  in  the  sciences  underlying 
nursing  work. 

Character  of  the  Training 

The  work  in  the  nursing  school  is  both  theo¬ 
retical  and  practical.  In  all  the  better  schools  the 
new  classes  come  in  at  certain  stated  periods,  and 
the  students  receive  some  preliminary  theoretical 
training  before  they  are  allowed  to  begin  their 
practical  work  in  the  wards.  The  probationary 
period  lasts  usually  from  two  to  six  months,  after 


12 


which  there  are  examinations  both  in  theoretical 
and  practical  work.  If  the  results  are  satisfactory 
the  applicant  is  retained  in  the  school.  After  the 
probation  period,  she  adopts  the  uniform  of  the 
school  and  enters  the  wards  as  a  pupil  nurse,  con¬ 
tinuing  her  class  and  lecture  work  throughout  the 
whole  course. 

Lecture  and  Class  Work. 

The  time  devoted  to  the  theoretical  work 
varies  a  great  deal  in  different  schools,  ranging 
from  about  two  to  six  hours  per  week,  except  in 
the  earlier  part  of  the  course,  when  from  ten  to 
eighteen  hours  per  week  may  be  given  to  theo¬ 
retical  work.  The  class  term  is  usually  from 
October  to  May,  while  the  practical  work  extends 
through  the  year. 

The  subjects  which  are  studied  in  a  nursing 
school  vary  somewhat,  but  usually  cover  the  gen¬ 
eral  sciences  underlying  nursing  work  {anatomy 
and  physiology,  bacteriology  and  chemistry) ,  the 
household  sciences  {cookery  and  nutrition,  die¬ 
tetics  and  hospital  housekeeping) ,  the  study  of 
disease  in  all  its  various  branches,  with  the  nurs¬ 
ing  measures  required  in  each  {medical,  surgi¬ 
cal  obstetrical,  children’s  infectious  diseases, 
etc.),  the  subjects  dealing  with  the  prevention 
and  treatment  of  disease  {hygiene  and  sanitation. 


13 


materia  medica,  massage,  etc.)  and  certain  gen¬ 
eral  subjects  which  deal  with  the  history  and 
ethics  of  nursing  and  the  social  and  professional 
aspects  of  the  nurse’s  work. 

The  main  part  of  the  teaching  is  usually  car¬ 
ried  on  by  nurse  instructors,  and  by  specialists 
in  the  various  branches  represented.  Physicians 
usually  give  the  lectures  on  disease  and  some¬ 
times  carry  on  the  work  in  some  of  the  sciences 
also. 

It  would  be  a  mistake  to  conclude  that  all  the 
theoretical  training  is  confined  to  the  classes  and 
lectures.  A  great  deal  of  the  most  valuable  teach¬ 
ing  the  pupil  gets  in  the  ward,  over  the  bed  of 
the  patient,  or  in  close  touch  with  actual  living 
conditions.  Supervisors  and  head-nurses  are 
usually  at  hand  to  direct  and  criticize  her  work, 
and  visiting  and  resident  physicians  add  their 
substantial  contribution  to  her  education. 

Technical  and  Executive  Experience  and  Prac¬ 
tice. 

The  practical  work  in  the  ward  (the  nurse’s 
laboratory),  gives  the  student  a  chance  to 
observe,  to  gain  skill  and  facility  in  nursing  pro¬ 
cedures,  and  to  acquire  confidence  and  control  in 
managing  herself  and  others.  The  work  proceeds 
usually  from  the  simpler  to  the  more  highly  tech- 


14 


nical  processes,  the  student  spending  a  few 
months  in  each  of  the  different  departments  of 
the  hospital.  As  she  gains  in  experience,  she  is 
promoted  to  positions  of  greater  and  greater 
responsibility,  and  so  develops  the  capacity  for 
leadership  and  organization,  which  stands  her  in 
good  stead  when  she  is  cut  loose  from  the  sys¬ 
tematized  and  regular  work  of  the  hospital. 

Nursing  Courses  Connected  ivith  Universities. 

The  present  system  of  education,  while  giv¬ 
ing  the  student  exceptional  advantages  in  the 
close  observation  and  care  of  sick  people,  pre¬ 
sents  some  limitations.  It  is  believed  that  many 
of  these  would  be  overcome  if  the  hospital  train¬ 
ing  school  could  be  connected  up  with  a  good 
college  or  university  where  most  of  the  funda¬ 
mental  scientific  training  could  be  given.  Such 
affiliations  have  now  been  established  in  several 
universities,  such  as  those  of  Minnesota,  Indiana, 
Cincinnati,  California,  Leland' Stanford,  Wash¬ 
ington  (St.  Louis)  and  Columbia  (New  York). 
A  combined  academic  and  professional  course  of 
five  years,  leading  to  the  Bachelor  of  Science 
Degree,  is  now  offered  by  the  Department  of 
Nursing  and  Health,  Teachers  College,  Columbia 
University,  in  cooperation  with  the  Presbyterian 
Hospital,  New  York  City.  Students  with  two 


15 


years  of  work  in  a  good  college,  normal  or  techni¬ 
cal  school,  would  require  only  three  years  for  the 
degree  and  nursing  diploma.  Similar  arrange¬ 
ments  can  be  made  in  several  of  the  above 
mentioned  universities.  Even  where  a  training 
school  has  no  organic  relationship  with  a  nearby 
college  or  medical  school,  it  is  often  able  to 
make  use  of  its  better  teaching  and  laboratory 
facilities,  and  so  improve  its  work. 

Cost  of  Tuition. 

In  a  few  schools  a  fee  is  charged  for  the  pre¬ 
paratory  course,  ranging  from  $25  to  $50.  Where 
this  preliminary  course  is  taken  in  a  college,  the 
fee  is  of  course  the  same  that  all  students  pay  in 
that  institution,  with  living  expenses  in  addition. 
In  most  schools  the  student  receives  her  tuition 
and  living  expenses  (which  include  room,  food 
and  laundry)  from  the  hospital  in  return  for 
her  services.  Hospitals  often  make  an  allow¬ 
ance  of  from  $4  to  $10  per  month  for  text¬ 
books,  uniforms  and  incidental  expenses,  but 
many  prominent  schools  have  given  up  this 
practice,  preferring  to  expend  the  money  on  bet¬ 
ter  teaching  facilities,  better  supervision,  and 
more  trained  instructors.  Where  the  instruction 
is  excellent  and  the  living  and  working  conditions 
are  good,  it  is  believed  that  the  pupil  has  a  full 


i6 


equivalent  for  her  services,  in  the  education 
received.  Where  these  conditions  do  not  hold,  no 
money  allowance  can  make  up  to  the  pupil  for 
their  lack.  In  several  schools  scholarships  are 
offered,  which  are  designed  to  assist  students  who 
prove  unusually  capable  either  in  their  studies  or 
in  practical  work. 

Conditions  of  Work  in  the  Hospital 

Effects  on  Health. 

Nursing  is  known  to  be  very  exacting  and 
responsible  work,  but  it  is  a  great  mistake  to 
think  of  it  as  exhausting  or  dangerous  to  health. 
Most  pupils  in  training  find  themselves  in  better 
condition  physically  than  before  they  entered  the 
hospital,  and  very  few  are  injured  by  the  work 
in  any  well-regulated  hospital.  The  regular 
hours,  the  wholesome  food,  and  the  physical 
activity,  as  well  as  the  unfailing  interest  of  the 
work  itself,  help  to  offset  any  disadvantages 
which  may  come  from  indoor  life,  fairly  long 
hours  and  contact  with  sickness.  On  the  whole, 
nurses  will  be  found  to  have  fewer  illnesses  than 
teachers  and  office  workers.  Pupil  nurses  receive 
free  medical  attendance  and  care  in  illness, 
though  the  time  lost  must  usually  be  made  up  in 
full. 


17 


Hours  of  Duty  and  Vacations. 

The  hours  of  pupil  nurses  in  most  hospitals 
have  always  been  too  long,  considering  the  class 
work  and  study  which  is  expected  of  the  students. 
The  tendency  is  all  toward  a  lowering  of  these 
hours  of  duty,  many  schools  now  adopting  the 
eight-hour  system.  Those  that  still  hold  to  a  nine 
or  ten-hour  day  give  one  free  afternoon  a  week. 
Students  are  usually  assigned  to  from  four  to 
eight  months  of  night  duty,  in  periods  of  from 
one  to  two  months’  duration,  any  time  during  the 
three  years.  Vacations  average  about  three 
weeks  yearly,  several  prominent  schools  giving 
one  month. 

Housing  and  Food. 

Improvements  in  living  conditions  for  nurses 
have  been  very  marked  in  recent  years.  Beauti¬ 
ful  residences  for  the  nursing  staff  are  a  feature 
of  many  modern  hospitals,  well  equipped  with 
class-rooms,  laboratories,  libraries  and  reception 
rooms.  The  food  served  to  pupil  nurses  will  com¬ 
pare  very  favorably  with  that  found  in  college 
dormitories  and  boarding  schools.  Some  schools 
have  country  and  summer  homes  where  pupil 
nurses  are  sent  for  change  and  recreation. 


i8 


Social  Life. 

The  life  in  the  hospital  is  too  intense  and 
absorbing  to  admit  of  many 'outside  social  activi¬ 
ties,  but  the  opportunities  for  observing  and 
knowing  all  kinds  of  human  beings  of  every  class 
and  type,  make  the  possibilities  of  social  develop¬ 
ment  rather  exceptional.  It  is  an  undisputed  fact 
that  numberless  nurses  look  back  to  the  years  of 
their  hospital  training  as  the  time  when  they  met 
the  most  interesting  people,  formed  the  closest 
friendships,  and  enjoyed  the  happiest  and  most 
memorable  experiences  of  their  lives.  The  nec¬ 
essity  for  recreation  and  outside  interest  is  being 
recognized  more  fully  in  all  the  better  schools. 
Provision  is  being  made  for  tennis  and  other  out¬ 
door  games ;  roof-gardens,  gymnasia  and  swim¬ 
ming  pools  have  been  added  to  some  of  the  newer 
homes,  and  classes  in  physical  training  and  danc¬ 
ing  are  often  provided.  Though  the  hour  for 
retiring  is  usually  about  lo;  30  P.  M.,  permission 
for  late  leave  is  granted  at  reasonable  intervals 
for  theaters  and  entertainments,  and  in  the 
nurses’  residence  very  jolly  class  parties,  recep¬ 
tions  and  dances  are  not  infrequent. 

Rules  and  Regulations. 

The  regulations  governing  the  Nurses’  Home 
are  much  the  same  as  for  any  large  dormitory. 


19 


In  a  number  of  schools  the  students  themselves 
have  much  to  do  with  making  and  enforcing  all 
the  general  regulations  of  the  home.  On  the 
wards,  however,  the  military  type  of  discipline  is 
still  in  force,  though  by  no  means  so  rigidly  exer¬ 
cised  as  in  the  old  days.  Where  matters  of  life 
and  death  are  at  stake,  the  habit  of  prompt  and 
implicit  obedience  to  orders  is  absolutely  neces¬ 
sary,  and  no  one  who  knows  the  conditions  to  be 
met  in  hospital  work,  questions  the  necessity  for 
the  loyal  co-operation  and  obedience  of  all  to 
those  in  command.  Outside  of  certain  more  or 
less  well-defined  limits,  however,  there  is  plenty 
of  room  for  the  nurse  to  exercise  her  judgment 
and  initiative  and  to  express  her  individuality. 
She  will  have  ample  opportunity  for  demonstrat¬ 
ing  her  ability  to  carry  responsibility,  to  organize 
and  direct  work,  and  to  lead  and  guide  others. 

Special  Interests  and  Satisfactions 

Wherever  there  is  serious  illness  there  will, 
of  course,  be  some  mental  and  nervous  strain,  but 
it  is  a  mistake  to  imagine  that  acute  or  distressing 
illness  is  the  rule  in  hospital  wards.  By  far  the 
largest  number  of  patients  are  either  moderately 
ill  or  on  the  way  to  recovery,  and  the  joy  of  see¬ 
ing  them  daily  mending  under  one’s  care  more 


20 


than  counter-balances  the  depressing  effects  of 
the  occasional  inevitable  tragedy. 

Probably  the  most  inspiring  part  of  the  work 
is  the  privilege  of  assisting  in  the  wonderful 
results  which  are  being  accomplished  by  the  great 
surgeons  and  by  other  leaders  in  the  field  of 
research  and  practical  medicine.  The  nurse’s 
work  is  a  most  essential  part  of  all  these  activities, 
and  so  she  has  a  vital  interest  in  every  detail  con¬ 
nected  with  them.  Nothing  seems  petty  or  unim¬ 
portant  when  the  purpose  of  the  whole  is  under¬ 
stood  ;  nothing  is  drudgery  which  ministers  to 
the  welfare  of  her  patient. 

The  nurse  sees  far  more  of  the  personal  and 
human  sideof  hospital  life  than  the  physician  does. 
She  gets  closer  to  her  patients,  and  being  con¬ 
stantly  with  them,  she  can  help  them  so  much 
more  in  all  their  various  interests  and  needs. 
There  is  a  strong  pull  on  all  that  is  best  in  a 
woman  when  she  feels  so  many  depending  on  her 
for  strength  and  comfort,  and  often  for  life. 
While  her  responsibilities  mature  her,  they 
strengthen  her,  and,  if  she  is  made  of  the  right 
stuff,  she  cannot  fail  to  be  a  better  and  more  use¬ 
ful  woman  for  all  the  experiences  she  has  gone 
through.  Sometimes,  of  course,  hard  things  have 
to  be  met,  as  in  all  other  ways  of  life  that  are 


21 


worth  while.  There  is  a  joyful  challenge  in  a 
difficult  task,  and  a  satisfaction  in  its  performance 
that  comes  only  to  those  who  dare  attempt  the 
harder  paths  of  duty.  These  subtle  satisfactions 
nurses  receive  in  full  measure. 

The  spectacular  and  sensational  pictures  of 
the  hospital  as  depicted  by  the  popular  novelist, 
are  rarely  true  to  life,  and  yet  there  is  much  that 
makes  a  strong  appeal  to  the  imagination  and  the 
sympathies,  even  in  the  most  ordinary  hospital 
ward.  Nowhere  does  one  find  more  high 
lights  and  shadows,  more  dramatic  situa¬ 
tions  and  more  fascinating  glimpses  of  human 
nature.  There  is  adventure  too,  and  heroism, 
and  lots  of  healthy  humor  to  keep  the  balance 
true. 


Qualifications  Required  in  Nursing 

Education. 

To  make  a  good  nurse,  one  must  have 
an  alert  and  understanding  mind,  good  judg¬ 
ment,  cultured  tastes  and  sufficient  knowl¬ 
edge  of  the  sound  fundamentals  on  which 
a  professional  training  can  be  built.  No 
diploma  is  a  guarantee  of  these  qualifications, 
but  we  know  that  they  are  rarely  found  except 
among  women  who  have  had  a  fair  amount  of 


22 


education.  The  better  schools  of  nursing  accept 
only  high  school  graduates.  Mature  women  who 
have  had  exceptional  experience  and  training  are 
sometimes  admitted  on  the  same  standing,  but  as 
a  rule  candidates  with  superior  education  are  pre¬ 
ferred.  College  women  in  increasing  numbers 
have  been  entering  nursing  schools  in  recent 
years,  and  even  the  brightest  feel  that  they  need 
all  the  resources  that  a  college  education  gives,  to 
enable  them  to  meet  the  higher  demands  of  the 
profession. 

Subjects  which  will  prove  of  especial  value 
to  the  prospective  nurse  are  Biology,  Bacteriol¬ 
ogy,  Hygiene,  Chemistry,  Physics,  Household 
Science  (including  Cookery,  Nutrition  and 
Housekeeping),  Sociology,  Psychology,  Ethics 
and  Economics.  Latin  is  useful  in  helping  to 
master  technical  terms.  Modern  languages  are 
of  considerable  service  in  the  hospital  wards  and 
subsequent  social  work.  English  and  History 
are  of  course  essential.  Arithmetic  is  necessary, 
but  Algebra  and  Geometry  are  of  little  practical 
value  except  in  the  study  of  chemistry  and 
physics.  Voice  Culture  is  one  of  distinct  value, 
while  Music  and  Drawing,  Games  and  Dancing, 
Art  and  Craft  Work,  and  other  accomplishments 
all  prove  serviceable  in  certain  types  of  nursing. 


23 


Lettering  is  required  in  most  schools  for 
charting  work.  Students  who  are  too  young  to 
enter  a  School  of  Nursing,  are  strongly  advised 
to  pursue  their  studies,  either  in  high  school  or 
college,  along  these  lines. 

Experience  in  the  management  of  a  good 
home,  training  in  domestic  science,  in  kinder¬ 
garten  work,  or  teaching  of  any  kind,  experi¬ 
ence  in  social  settlement  work  —  anything  that 
trains  the  eye  to  observe  accurately  and  the  mind 
to  act  quickly  and  surely;  that  broadens  one’s 
outlook  and  develops  one’s  sympathies ;  that 
gives  understanding  and  experience  in  the  hand¬ 
ling  of  people ;  that  trains  the  hands  in  deftness 
and  fineness  of  touch ;  that  gives  one  orderly  and 
systematic  habits ;  that  enables  one  to  pursue  a 
given  course  seriously  and  intelligently  —  all 
these  help  in  fitting  one  to  be  a  better  nurse. 

Character  and  Personality. 

Good  nurses  are  not  made  from  any  stereo¬ 
typed  pattern.  Indeed,  there  is  no  profession 
where  individuality  is  more  needed,  and  where 
people  of  varying  temperament  and  personality 
will  find  a  wider  range  of  congenial  occupations. 
There  are,  however,  a  few  essentials  in  consider¬ 
ing  one’s  fitness  for  this  work.  A  nurse  should 
be  strong,  because  people  will  lean  on  her;  she 


24 


should  be  truthworthy  because  people  will  confide 
in  her ;  she  must  have  a  certain  steadiness  and 
self-reliance,  for  heavy  responsibilities  will  some¬ 
times  be  put  on  her.  Needless  to  say,  she  should 
have  the  spirit  of  service,  and  a  sincere  interest 
in  human  beings  of  all  classes  and  kinds.  Tact, 
and  the  right  kind  of  sympathy,  are  highly 
important ;  a  sense  of  humor,  resourcefulness 
and  adaptability  one  would  be  inclined  to  put 
among  the  essentials.  Many  other  desirable  quali¬ 
ties  will  be  developed  by  the  right  kind  of  a  train¬ 
ing.  Certain  types,  such  as  the  incurably  lazy, 
sentimental,  frivolous,  morbid  or  unreliable  girl, 
have  no  place  in  a  nursing  school,  but  on  the 
other  hand,  it  is  astonishing  what  unsuspected 
powers  may  be  developed  and  what  objectionable 
traits  may  be  eliminated  by  the  demands  of  a 
serious  and  responsible  task  which  requires  one’s 
best  effort. 

Physical  Qualifications. 

It  is  important  that  the  student  nurse  should 
have  good  general  health,  but  it  is  a  mistake  to 
assume  that  nursing  demands  any  unusual  phy¬ 
sique  or  exceptional  strength.  Size  is  not  a  very 
important  factor,  though  the  well-built  young 
woman  of  average  height  and  weight  is  of  course 
preferred.  The  age  of  entrance  varies  in 


25 


different  schools,  usually  between  nineteen 
and  thirty-five  years.  The  best  age  at  which  to 
begin  a  nursing  course  is  from  twenty-one  to 
twenty-five  years.  Seventeen  or  eighteen  years  is 
considered  too  young,  unless  the  girl  is  steadied 
and  matured  by  unusual  responsibilities,  and  is 
physically  well-developed.  Any  deformity  or 
weakness  in  feet,  hands  or  back  would  be  of 
serious  disadvantage ;  a  weak  throat  and  chest,  a 
bad  heart,  or  poor  hearing  or  vision  would  dis¬ 
qualify.  Most  nursing  schools  demand  a  certifi¬ 
cate  of  health  from  a  reputable  physician  before 
a  pupil’s  entrance,  and  insist  on  a  thorough  physi¬ 
cal  examination  before  accepting  her.  This  is  a 
protection  both  to  the  school  and  the  student. 
Teeth  and  eyes  should  be  attended  to  before 
entering  the  hospital,  and  one  should  enter  in  the 
best  possible  physical  condition. 

Positions  and  Remuneration 

The  field  of  nursing,  as  already  stated,  is 
expanding  at  a  very  rapid  rate.  In  no  other  pro¬ 
fession  for  women  is  there  such  a  wide  variety  of 
positions  to  choose  from.  Private  nursing  is 
undoubtedly  the  most  familiar  field  to  the  general 
public,  but  it  does  not  represent  at  all  adequately 
the  possibilities  open  to  progressive  women  in 
the  field  of  nursing  today.  Women  of  exceptional 


26 


executive  ability  usually  choose  institutional  or 
administrative  positions ;  those  who  are  inter¬ 
ested  in  the  educational  and  scientific  phases  of 
the  work  become  superintendents,  teachers  or 
technical  assistants.  The  woman  whose  inter¬ 
est  is  centered  in  the  human  and  social  side 
of  nursing  has  a  large  number  of  fields  to  choose 
from.  Some  of  these  positions  are  briefly 
described  below,  with  the  salaries  that  may 
usually  be  expected  in  them. 

Private  Nursing. 

The  work  of  the  private  nurse  may  be  either 
in  the  home  or  the  hospital,  where  she  will  be 
responsible  for  the  bed-side  care  and  treatment 
and  the  general  welfare  of  individual  sick 
patients.  Of  recent  years  there  has  been  a  demand 
for  specialists  in  private  nursing  who  are  qualified 
to  give  expert  care  in  certain  classes  of  disease, 
such  as  children’s  diseases,  mental  and  nervous 
diseases,  maternity  work,  etc.  The  hours  of  pri¬ 
vate  duty  are  usually  long  and  the  life  somewhat 
exacting.  The  interest  of  the  work  varies  much 
with  the  personality  of  the  patient  and  the  acute¬ 
ness  of  the  disease.  Opportunities  for  travel  and 
the  very  interesting  experiences  of  social  life 
among  all  classes  of  people  are  felt  to  be  some 
compensation  for  the  lack  of  personal  freedom 


27 


when  on  actiA^e  duty.  Between  cases  the  private 
nurse  is  absolutely  free,  and  her  vacations  are 
usually  at  her  own  disposal. 

Salaries  for  private  nurses  vary  in  diflferent 
parts  of  the  country.  The  minimum  for  general 
cases  is  usually  from  $20  to  $28  per  week,  while 
the  specially  trained  and  experienced  woman  may 
receive  from  $30  up  for  her  services.  It  must  be 
remembered,  however,  that  cases  are  often  short, 
and  sometimes  exhausting,  and  there  is  a  good 
deal  of  time  when  the  private  nurse  cannot  be 
actively  employed.  The  average  yearly  income 
of  the  private  nurse  is  believed  to  be  about  $900. 
When  on  duty  she  receives  her  living,  but  she 
has  a  room  always  to  keep  up,  and  she  must  pro¬ 
vide  for  her  living  expenses  when  off  duty.  In 
the  larger  centers,  there  are  always  a  few  posi¬ 
tions  where  nurses  are  engaged  from  year  to  year 
in  wealthy  families.  Others  do  hourly  nursing, 
which  means  that  the  nurse  lives  in  her  own 
home  and  is  called  out  much  as  a  doctor  is,  to 
assist  in  operations,  give  special  treatments,  etc., 
for  which  she  is  paid  by  the  hour. 

The  number  of  private  nurses  is  usually 
fairly  adequate  in  cities,  though  towns  and 
country  districts  often  suffer  for  lack  of  good 
nurses.  A  competent  private  nurse  of  agreeable 


28 


personality  is,  however,  practically  sure  of  con¬ 
stant  employment.  She  usually  joins  a  nurses’ 
registry,  which  keeps  her  in  touch  with  physicians 
and  the  public. 

Hospital  and  Training  School  Positions. 

Positions  in  hospitals,  sanatoria,  etc.,  may  be 
those  of  superintendent,  assistant  superintendent, 
supervisor,  head-nurse,  operating  room  nurse, 
matron  of  nurses’  home,  dietitian,  etc.  Officers 
of  training  schools  are  usually  considered  also  as 
officers  of  the  hospital,  but  they  are  more  specific¬ 
ally  concerned  with  the  education  of  the  nurses. 
Very  often  in  smaller  institutions  the  positions  of 
superintendent  of  hospital  and  training  school  are 
combined.  The  position  of  superintendent  of  a 
nursing  school  is  usually  comparable  in  dignity 
and  importance  with  that  of  dean  of  a  small 
college  or  principal  of  a  school.  The  instructor 
of  nurses  usually  gives  her  whole  time  to  class 
work,  and  occupies  much  the  same  kind  of  a  posi¬ 
tion  as  that  of  instructor  in  any  professional  or 
technical  school,  except  that  she  usually  lives  in 
the  hospital.  A  few  positions  as  visiting 
instructor  are  opening  up,  and  several  teaching 
positions  in  universities  are  now  available.  Posi¬ 
tions  as  dietitians  and  housekeepers  in  hospitals 
are  also  open  to  qualified  nurses,  and  there  is  an 


29 


increasing  demand  for  nurses  with  special  train¬ 
ing  in  these  branches. 

The  technical  specialties  in  the  hospital 
include  the  work  of  the  operating-room  nurse, 
the  nurse  anesthetist,  the  assistant  in  electro¬ 
therapy  and  X-Ray  work,  the  expert  in  massage, 
hydrotherapy  and  mechano-therapy ,  and  the  lab¬ 
oratory  assistant.  The  last-mentioned  fields  are 
not  so  common,  but  the  demand  for  nurses  in 
them  is  increasing.  A  new  branch  of  institu¬ 
tional  work  where  nursing  training  is  a  distinct 
asset,  is  that  of  occupations  for  invalids.  Several 
nurses  are  now  employed  as  teachers  of  occu¬ 
pation  therapy.  For  most  of  these  executive 
teaching  and  technical  positions,  additional 
training  and  experience  outside  of  the  regu¬ 
lar  hospital  course,  while  not  as  yet  com¬ 
pulsory,  is  very  advisable.  The  Department 
of  Nursing  and  Health  in  Teachers  College, 
Columbia  University,  offers  advanced  courses  to 
graduate  nurses  who  wish  to  fit  themselves  for 
executive  and  teaching  posts,  as  well  as  for  the 
fields  of  Public  Health  Nursing. 

Salaries  of  superintendents  vary  from  about 
$ioo  to  $250  per  month,  the  average  probably 
being  about  $100  per  month.  Assistants,  anaes¬ 
thetists  and  dietitians  receive  from  about  $50 


30 


to  $100  per  month,  averaging  about  $75;  head 
nurses  get  from  $40  to  $60  and  instructors 
from  $75  to  $100.  All  institutional  posi¬ 
tions  include  room,  board  and  laundry  unless 
specified  to  the  contrary.  There  is  a  steady 
demand  for  good  institutional  workers,  especially 
for  women  of  broad  education  and  experience,  of 
good  administrative  ability,  and  forceful  person¬ 
ality. 

Ptiblic  Health  Nursing. 

This  term  includes  a  number  of  varying 
activities,  all  of  which  are  definitely  concerned 
with  public  health  and  social  betterment.  It  is 
largely  preventive  and  educational  work  though 
it  also  concerns  itself  with  the  personal  care  of 
the  sick  in  the  home.  District  or  visiting  nursing 
is  the  oldest  of  these  branches,  and  all  the  other 
activities  may  be  said  to  be  ofif-shoots  or  special 
forms  of  district  nursing.  Some  of  these  visiting 
nurses  are  primarily  devoted  to  the  care  of 
mothers  and  small  babies ;  some  to  mental  and 
nervous  patients ;  others  to  tuberculous  patients, 
etc.  Infant  zvelfare  zvork  includes  the  actual  care 
of  sick  babies  as  well  as  the  teaching  of  mothers. 
It  is  carried  on  in  the  homes,  in  schools,  in  dispen¬ 
saries,  milk  stations,  fresh  air  camps,  etc.  Com¬ 
bined  with  it  or  existing  as  a  special  branch  is 


31 


prenatal  nursing,  which  deals  with  the  care  and 
teaching  of  expectant  mothers.  Insurance  nurs¬ 
ing  differs  only  in  that  the  nurses  are  paid  by  the 
insurance  companies  for  visiting  industrial  policy 
holders  who  are  sick  and  helping  to  keep  them 
well.  If  health  insurance  becomes  compulsory 
as  it  may  in  a  few  years,  this  branch  of  nursing 
would  be  tremendously  increased. 

Visiting  nursing  in  rural  districts  and  small 
tozvns,  combines  all  these  types  of  work  and  often 
includes  school  nursing  as  well.  Rural  nurses 
often  join  The  Town  and  Country  Nursing  Ser¬ 
vice  of  the  Red  Cross,  which  carries  this  work 
into  the  more  remote  pioneer  districts,  as  well  as 
the  better-populated  sections  of  the  country.  A 
similar  service  in  country  districts  is  often  carried 
on  by  State  Boards  of  Health,  and  private  organi¬ 
zations. 

In  all  these  branches  of  public  health  nursing 
directors  and  organizers  are  paid  from  about  $ioo 
to  $150  per  month,  usually  without  living 
expenses.  The  general  worker  receives  usually 
from  $60  to  about  $85  per  month.  A  few  posi¬ 
tions  as  directors  and  instructors  in  schools  for 
public  health  nurses  are  available,  the  salaries 
being  much  the  same  as  for  superintendents. 


32 


Social  Service  and  Welfare  Work. 

This  work  differs  from  the  preceding  only  in 
that  there  is  usually  less  actual  nursing  done,  and 
the  positions  are  open  to  other  workers  besides 
nurses.  Hospital  social  service  aims  to  conserve 
the  patient’s  strength  while  he  is  in  the  hospital 
and  after  he  leaves,  by  attending  to  home  condi¬ 
tions,  getting  him  the  right  kind  of  employment, 
securing  proper  food,  and  putting  him  into  rela¬ 
tions  with  agencies  which  will  help  him.  Welfare 
work  in  department  stores  and  factories  is  speci¬ 
ally  designed  to  improve  sanitary  conditions,  to 
advise  and  teach  employees  how  to  keep  well,  to 
see  that  they  get  proper  attention  when  sick 
and  to  render  first  aid  in  accidents.  Nurses  are 
preferred  in  all  of  these  positions  if  they  have  the 
other  essential  qualifications.  The  salaries  are 
from  about  $75  to  $125,  without  maintenance. 

Philanthropic  societies,  specializing  in  Child 
Welfare,  Mental  Hygiene,  Red  Cross,  Tubercu¬ 
losis  work,  etc.,  often  secure  the  services  of 
nurses  as  secretaries  for  organization  and  pub¬ 
licity  work.  The  salaries  offered  are  usually  from 
$100  to  $200  per  month.  Other  lines  of  social 
activity  in  which  nurses  have  proven  themselves 
successful  are  sanitary  inspection,  sanitary  inves- 


33 


tigation,  zvork  zjuith  defectives  and  criminals, 
police  matron  zvork,  and  probation  zvork. 

School  Nursing. 

This  is  an  extension  of  visiting  nursing,  but 
it  is  fast  becoming  a  distinct  branch  by  itself.  Its 
activities  lie  in  both  the  school  and  the  home,  and 
the  opportunities  for  educational  and  preventive 
work  are  very  great.  School  nurses  usually 
receive  from  about  $75  to  $100  per  month,  with¬ 
out  living  expenses.  The  hours  are  shorter,  how¬ 
ever,  and  the  duties  are  not  so  heavy  as  in  some 
other  branches  of  nursing.  Resident  nurses  in 
hoarding  schools  and  colleges  have  more  actual 
nursing  to  do,  and  are  often  expected  to  teach 
hygiene  in  the  class-room  as  well  as  to  individual 
students.  The  hours  are  usually  long  and  the 
duties  rather  exacting,  but  these  conditions  will 
doubtless  be  remedied  as  the  work  becomes  better 
organized.  Salaries  range  from  $50  to  $100  with 
maintenance. 

O  ffice  Nurse  and  Laboratory  Assistant. 

Physicians,  surgeons  and  dentists  often 
employ  nurses  as  assistants  in  their  office  prac¬ 
tise.  They  prepare  for  examinations  and  oper¬ 
ations,  do  routine  bacteriological  examinations, 
give  electrical  treatments,  massage,  etc.,  and  gen- 


34 


erally  assist  the  physician.  "Salaries  vary  much 
—  generally  from  $6o  to  $ioo  per  month,  without 
maintenance. 

Nurses  are  also  employed  in  bacteriological 
and  research  laboratories.  Salaries  here  are 
usually  $25  to  $100  per  month. 

Army,  Navy  and  Red  Cross  Nursing. 

Nurses  who  enter  the  army  and  navy  service 
in  times  of  peace  are  detailed  to  one  of  the  regu¬ 
lar  army  or  navy  hospitals,  where  their  work  is 
somewhat  similar  to  that  in  civilian  hospitals. 
They  are  an  integral  part  of  the  army  or  navy 
personnel,  and  are  under  the  same  general  regu¬ 
lations  as  other  members  of  those  forces.  In 
times  of  war,  they  serve  either  in  the  field  or  in 
the  base  hospitals  at  home.  The  salaries  range 
from  $60  to  $100  per  month,  including  main¬ 
tenance. 

Red  Cross  nurses  are  graduate  nurses  who 
are  regularly  occupied  in  other  fields  of  work, 
but  who  have  enlisted  with  the  American  Red 
Cross  nursing  service  for  emergency  duty  in 
event  of  war  or  other  national  calamities.  They 
are  pledged  to  respond  at  any  time  to  the  call  of 
the  Red  Cross,  for  service  either  at  home  or 
abroad.  When  the  country  is  at  war,  the  various 
nursing  corps  are  first  recruited  by  the  Red  Cross 


35 


and  then  transferred  to  the  regular  army  or  navy 
medical  service.  Only  thoroughly  qualified 
nurses  from  registered  hospitals  are  accepted  for 
the  Red  Cross  nursing  service.  Salaries  range 
from  $6o  per  month  up,  including  maintenance. 

Nursing  in  Home  and  Foreign  Mission  Fields 

The  work  is  really  very  much  the  same  here 
as  district  and  hospital  work  at  home.  The  scarc¬ 
ity  of  nurse  volunteers  has  seriously  handicapped 
the  work  in  many  of  the  foreign  posts,  and 
women  who  have  had  this  training  will  always  be 
eagerly  welcomed.  Salaries  vary  much  with  dif¬ 
ferent  countries  and  conditions,  but  is  usually  on 
the  .same  basis  as  other  missionary  helpers.  The 
most  thrilling  tales  of  pioneer  work  among  the 
mountain  Avhites  of  North  Carolina,  and  the  fish¬ 
ermen  of  labrador  rival  anything  that  has  been 
told  of  the  far-oflf  fields.  Here  also  the  need  is 
very  great. 

Opportunities  for  Advancement  and 
Future  Development 

In  addition  to  these  fields  which  have  been 
more  or  less  clearly  marked  out,  there  are  a  num¬ 
ber  which  offer  opportunity  for  pioneer  effort. 
The  whole  field  of  mental  and  insane  work  is 
calling  for  expert  nurses ;  almshouses  must  also 


36 


be  reclaimed  from  the  hands  of  ignorant  and 
untrained  workers  ;  occupational  work  for  mental 
patients  and  for  the  physically  handicapped  needs 
to  be  developed  and  scientifically  studied ;  and  the 
work  of  the  foreign  midwife  must  be  improved 
and  possibly  replaced  by  a  more  satisfactory  ser¬ 
vice.  Many  other  branches  of  public  welfare 
work  are  waiting  for  investigation  and  organiza¬ 
tion.  The  problems  are  all  extremely  practical 
and  vital  to  public  welfare.  The  nursing  body 
has  done  much,  but  it  needs  reinforcements.  The 
system  of  education  in  nursing  is  itself  under¬ 
going  radical  changes  and  particularly  calls  for 
educated  women.  Any  one  of  these  problems 
offers  scope  for  the  highest  kind  of  intellectual 
and  administrative  ability  that  can  be  secured. 

It  will  be  seen  from  the  foregoing  that  there 
is  no  lack  of  opportunity  for  the  right  kind  of 
women.  Especially  are  needed  leaders,  who,  in 
addition  to  wide  culture,  and  excellent  profes¬ 
sional  training,  have  the  capacity  for  enthusiastic, 
whole-hearted,  constructive  effort.  No  one  will 
succeed  who  is  afraid  of  work.  Experience  shows 
that  wherever  women  have  demonstrated  their 
fitness  for  superior  service,  salaries  have  usually 
risen  to  meet  them.  Fortunately,  most  of  the 
good  women  in  nursing  regard  salary  as  a  second- 


37 


ary  matter.  The  main  thing  is  the  opportunity 
for  real  service,  and  this  is  positively  unlimited. 
Nurses  are  founding  settlements,  directing  phil¬ 
anthropies,  organizing  local  and  national  health 
movements,  occupying  positions  on  the  most  in¬ 
fluential  committees,  teaching  in  colleges,  editing 
magazines,  lecturing — indeed  there  are  almost  no 
fields  of  public  service  in  which  they  are  not  en¬ 
gaged,  and  in  which  they  may  not  aspire  to  serve. 

Advantages  Over  Other  Vocations  for  Women 
Compared  with  other  professions  for  women, 
nursing  has  many  advantages.  Almost  from  the 
beginning  the  pupil  nurse  is  engaged  in  real  living 
problems,  not  merely  in  an  abstract  preparation. 
The  training  requires  no  large  financial  outlay, 
her  services  covering  expenses  of  tuition  and  to  a 
great  extent  expenses  of  living  as  well.  She  does 
not  have  to  face  the  competition  from  men  which 
meets  women  in  every  other  profession,  and  so 
far  there  has  been  little  competition  among 
nurses  themselves.  The  day  she  graduates  the 
nurse  may  usually  begin  her  work,  without 
searching  for  a  position  or  waiting  for  a  tardy 
practise  to  grow  up.  She  requires  no  expensive 
outfit  to  keep  up,  and  so  long  as  health  lasts,  she 
has  an  assured  income.  She  need  not  remain  in 
any  fixed  place,  for  wherever  she  goes,  if  she  is  a 


38 


competent  woman,  she  is  likely  to  find  some 
demand  for  her  services.  If  she  wishes  to  go 
into  any  other  fields  of  work,  her  nursing  train¬ 
ing  is  always  a  valuable  asset.  In  times  of  war 
and  national  calamity,  it  places  her  in  the  first  line 
of  defense  and  enables  her  to  render  probably  the 
most  valuable  service  it  is  in  the  power  of  any 
woman  to  give  to  her  country. 

The  great  objection  raised  to  many  of 
women’s  occupations  is  that  they  unfit,  or  at  least 
do  not  help  in  fitting  a  young  woman  for  her 
probable  future  as  a  homekeeper  and  a  mother. 
Nursing  is  the  best  possible  preparation  for  these 
vocations.  It  gives  training  in  management,  in 
cookery  and  dietetics,  in  sanitation  and  the  care 
of  children,  and  in  many  other  branches  which 
are  of  distinct  value  in  the  keeping  of  a  home. 
In  addition  nurses  have  abundantly  shown  that 
their  unusual  opportunities  for  knowing  human 
nature  and  observing  social  problems,  and  their 
practical  grasp  of  effective  measures,  make  them 
especially  valuable  citizens  in  any  community. 
From  these  points  of  view,  one  would  be  inclined 
to  recommend  the  training  for  almost  all  women. 

In  a  recent  address  by  Lady  Helen  Monroe 
Ferguson  on  “  The  Nurse  as  a  Citizen  ”  she  con¬ 
gratulates  nurses  on  the  fact  that  their  horizon. 


39 


instead  of  being  narrowed,  is  constantly  being 
set  farther  back,  and  that  their  work,  instead  of 
tending  to  contraction  of  character  and  impover¬ 
ishment  of  soul,  tends  to  bring  into  play  every 
quality  which  they  possess.  The  possibilities  of 
social  usefulness  and  of  self-development  are 
limited  only  by  their  own  capacity.  This  cannot 
be  said  of  a  great  many  other  occupations. 

Suggestions  for  Entering  the  Nursing 
Profession 

There  is  no  way  of  becoming  a  recognized 
member  of  the  nursing  profession  except  through 
graduating  from  a  good  training  school.  The 
cheap,  short-cut  methods  have  all  proven  futile 
and  deceptive.  Correspondence  courses  can  no 
more  train  one  to  be  a  nurse  than  they  can  train 
a  soldier  or  the  captain  of  a  vessel.  The  results 
of  ignorance  might  not  be  so  great  in  an  occupa¬ 
tion  like  stenography,  or  an  art  like  music  or 
painting;  but  where  they  are  disastrous  to  life 
and  human  welfare,  ignorance  and  incompetence 
become  little  less  than  criminal. 

Just  as  in  medicine  or  any  other  pro¬ 
fession,  the  status  of  the  nurse  in  the  community 
and  among  her  co-workers  depends  a  great  deal 
on  the  prestige  of  the  school  from  which  she 
received  her  training.  Without  a  diploma  from  a 


40 


reputable  school,  she  cannot  look  forward  to 
occupying  any  important  positions,  or  winning  the 
confidence  of  a  discriminating  public.  The  choice 
of  a  good  school  is  thus  of  the  highest  importance. 
Unfortunately,  we  have  in  this  country  a  large 
number  of  hospitals  where  the  economic  value  of 
the  work  done  by  the  pupil  nurse,  and  not  her 
education,  is  the  prime  and  only  consideration. 
One  may  get  a  certain  kind  of  experience  in  such 
an  institution,  but  no  consecutive  or  systematized 
teaching.  No  money  inducements,  or  low  age  or 
educational  standards,  should  tempt  anyone  to 
enter  such  a  school. 

Before  making  a  choice,  applicants  should 
visit  several  schools  or  write  making  full  inquiries 
regarding  the  following  conditions.  All  good 
schools  welcome  visitors  and  are  glad  to  answer 
inquiries  about  their  work.  Many  mothers  have 
been  induced  to  forego  their  prejudices  and  allow 
their  daughters  to  take  up  nursing,  after  a  visit  to 
a  good  up-to-date  institution.  The  important 
points  to  be  considered  will  be  — 

Size  of  School  and  Character  of  Service. 

It  is  not  necessary  that  the  hospital  should 
be  a  very  large  institution.  A  small  hospital  (not 
less  than  fifty  beds)  may  give  a  good  training  if 
it  connects  itself  with  other  and  larger  institu- 


41 


tions.  The  scope  and  character  of  the  work  done 
is  of  the  greatest  importance.  Training  in  a  loo¬ 
ked  general  hospital  with  an  active  and  varied 
service  is  usually  more  profitable  than  in  a  much 
larger  institution,  which  cares  for  only  a  few 
kinds  of  diseases,  and  those  more  or  less  chronic 
in  character. 

Reputation. 

The  value  of  a  nursing  school  is  not  always 
directly  proportioned  to  the  prestige  and  reputa¬ 
tion  of  the  hospital  with  which  it  is  connected. 
Some  hospitals  that  have  built  up  a  reputation  on 
the  work  of  a  brilliant  surgeon,  or  a  magnificent 
building,  give  their  nurses  very  inadequate  train¬ 
ing.  The  reputation  of  the  nursing  school 
depends  on  the  standards  set  for  the  actual  care 
of  the  patient  and  the  training  of  the  nurse. 

Standards  of  Entrance. 

If  there  are  no  educational  requirements  at 
all,  or  if  they  are  very  low,  it  is  fair  to  draw  the 
conclusion  that  the  educational  work  is  not  of  a 
high  character.  Most  of  the  better  schools 
demand  a  high  school  certificate  or  its  equivalent. 
If  one  cannot  meet  this  moderate  standard,  it  is 
usually  better  to  make  good  one’s  deficiencies 
rather  than  enter  the  school  which  has  lower 


42 


standards  of  education.  High  schools,  evening 
schools  and  special  courses,  enable  any  ambitious 
woman  to  meet  these  educational  requirements. 

The  Course  of  Study. 

Though  lectures  and  classes  are  not  the  all- 
important  thing  in  a  nurse’s  training,  they  are  a 
pretty  fair  indication  of  the  standards  which  the 
school  considers  important.  A  few  unrelated, 
unsystematized  lectures  by  even  the  ablest  physi¬ 
cians  will  never  take  the  place  of  systematized 
and  continuous  teaching  by  the  nursing  staff.  The 
extent  of  this  class  teaching  and  the  thoroughness 
with  which  it  is  organized  is  a  fair  measure  of  the 
efficiency  of  a  school. 

The  Character  and  Capacity  of  the  Teaching 

Staff. 

It  is  impossible  to  too  strongly  emphasize 
this  point,  for  the  school  to  a  great  extent  takes 
its  tone,  not  from  the  physicians  and  the  board  of 
managers,  but  from  the  principal  of  the  school 
and  her  assistants.  Well-educated,  broad-minded, 
progressive  women  at  the  head,  will  make  up  for 
a  great  many  deficiencies ;  and  though  no  degree 
or  title  can  guarantee  these  things,  nurses  them¬ 
selves  place  greater  reliance  on  those  who  can 
put  R.  N.  after  their  names.  (See  p.  44.)  If, 


43 


in  addition,  a  superintendent  or  teacher  has  had 
large  experience  in  important  posts  or  has  taken 
postgraduate  work  to  fit  her  better  for  her  posi¬ 
tion,  a  better  quality  of  teaching  is  usually 
insured. 

Living  and  Working  Conditions. 

These  are  important  considerations,  for  one’s 
health  and  efficiency  depend  to  such  a  great 
extent  on  them.  Any  school  that  still  holds  to  a 
ten  or  twelve-hour  working  day,  and  a  one  or  two 
weeks’  vacation,  need  not  expect  to  receive  appli¬ 
cations  from  discriminating  women.  A  number 
of  schools  still  send  their  pupils  out  on  private 
duty  during  their  course  of  training,  the  hospital 
receiving  certain  remuneration  for  their  services. 
The  best  authorities  in  the  nursing  profession  feel 
that  this  is  a  profound  injustice  to  the  pupil  nurse, 
since  it  interferes  with  her  course  of  study, 
removes  her  from  the  supervision  of  her  instruc¬ 
tors  and  greatly  limits  her  opportunity  for  obser¬ 
vation  and  practise. 

Standing  of  the  Alumnae  of  the  School. 

This  is  also  a  fair  test  of  the  value  of  a  train¬ 
ing.  If  former  pupils  are  occupying  prominent 
positions  all  over  the  country,  if  they  are  repre¬ 
sented  in  professional  organizations  and  in  public 


44 


and  social  enterprises,  the  school  is  likely  to  have 
good  traditions  of  training'. 

Registration. 

It  would  be  wise  for  all  intending  applicants 
to  inquire  whether  the  school  they  think  of  enter¬ 
ing  is  registered  in  its  state,  and  whether  its  grad¬ 
uates  are  eligible  to  the  title  of  Registered  Nurse 
(R.  N.).  Owing  to  the  united  efforts  of  nurses, 
laws  have  been  passed  in  most  of  the  states  for 
the  purpose  of  upholding  good  standards  of  edu¬ 
cation,  and  giving  the  public  some  means  of 
determining  the  qualifications  of  women  practis¬ 
ing  as  nurses.  Schools  which  meet  certain  mini¬ 
mum  requirements  are  allowed  to  register.  Their 
graduates  only  are  eligible  for  the  state  examina¬ 
tion,  and  for  the  certificate  which  the  state  gives. 
In  a  few  states,  no  one  may  practise  as  a  nurse 
who  does  not  pass  this  examination,  and  the  like¬ 
lihood  is  that  very  soon  such  compulsory  regis¬ 
tration  will  be  general.  Already  several  large 
organizations  employing  nurses  (such  as  the  New 
York  Board  of  Health  and  the  National  Red 
Cross  Society)  have  decreed  that  they  will  receive 
applications  only  from  registered  nurses,  and 
practically  all  the  professional  organizations  re¬ 
quire  this  qualification  (where  such  laws  are  in 
force)  for  membership.  While  registration  either 


45 


of  hospital  or  nurse,  is  not  to  be  regarded  as  a 
testimonial  of  high  efficiency,  it  shows  that  cer¬ 
tain  fundamental  standards  have  been  met. 

If  in  doubt  about  the  reputation  of  a  school 
it  would  be  wise  to  consult  some  official  of  the 
States  Nurses’  Association,  or  to  write  to  the  edi¬ 
tor  of  a  reliable  nursing  periodical,  one  or  two  of 
which  are  mentioned  below. 

In  the  list  of  references  below  will  be  found 
much  fuller  discussions  of  the  history  and  scope 
of  nursing  and  its  place  in  the  work  of  the  world 
to-day. 


References ; 

Nutting,  M.  Adelaide,  and  Dock,  Lavinia  D.' — 
History  of  Nursing.  4  Vols.,  Putnams,  1907  and 
1912. 

Cook,  Sir.  Edward  —  Life  of  Florence  Nightingale. 
2  Vols.  Macmillan  Co. 

Nightingale,  Florence  —  Notes  on  Nursing  —  What 
it  is  and  what  it  is  not.  Appleton,  i860. 

Wald,  Lillian  D.  —  The  House  on  Henry  Street. 
Holt,  1915. 

Gardner,  Mary  S.  —  Public  Health  Nursing.  Mac¬ 
millan  Co.,  1916. 

Epler,  Percy  H.  —  The  Life  of  Clara  Barton.  Mac¬ 
millan  Co.,  1916. 

Tiffany,  Francis  —  Life  of  Dorothea  Lynde  Dix. 
Houghton-Mifflin,  1896. 


46 


Richards,  Linda  —  Reminiscences  of  Linda  Rich¬ 
ards.  Whitcomb  &  Barrojvs,  1911. 

Boardman,  Mabel  —  Under  the  Red  Cross  Flag. 

Loane,  M.  —  The  Queen’s  Poor,  The  Next  Street 
but  One,  From  Their  Point  of  View,  Neighbors  and 
Friends,  etc.  (Contain  very  interesting  descrip¬ 
tions  of  the  experiences  of  a  visiting  nurse  in  Lon¬ 
don.)  Arnold,  London. 

Saleeby,  C.  W.  —  Surgery  and  Society  (Chap.  XIII 
—  Florence  Nightingale.  Chap.  XIV  —  The  Modern 
Nurse).  Herbert  &  Daniel,  1912. 

Nutting,  M.  Adelaide  —  Educational  Status  of 
Nursing  —  Bulletin  of  the  U.  S.  Bureau  of  Educa¬ 
tion,  No.  475,  Government  Printing  Office,  Wash¬ 
ington,  1912. 

Wald,  Lillian  D.  —  Article  on  Nursing  in  Vocations 
for  the  Trained  Woman.  Edited  by  Agnes  F. 
Perkins  and  published  by  the  Woman’s  Educational 
and  Industrial  Union,  Boston;  also  a  Vocational 
pamphlet  on  Nursing,  published  by  same  organi¬ 
zation. 

Morley,  Edith  —  Women  Workers  in  Seven  Pro¬ 
fessions  (Sec.  Ill  Nursing).  Routledge,  1914. 

Cannon,  Ida  M.  —  Medical  Social  Service,  Bulletin 
No.  II,  published  by  the  Appointment  Bureau, 
Woman’s  Educational  and  Industrial  Union,  264 
Boylston  Street,  Boston,  Mass.,  1912. 

Journals  : 

American  Journal  of  Nursing  —  Editorial  Office, 
45  South  Union  St.,  Rochester,  N.  Y. 

British  Journal  of  Nursing  —  Nursing  Press  Ltd., 
4.31  Oxford  St.,  London. 


47 


Canadian  Nurse  —  Canadian  Nurse  Publishing  Co., 
408  McKinnon  Building,  Toronto,  Canada. 

Public  Health  Nurse  Quarterly,  501  St.  Claire  St., 
Cleveland,  Ohio. 

Pacific  Coast  Journal  of  Nursing  —  721  Call  Build¬ 
ing,  New  Montgomery  and  Jesse  Sts.,  San  Fran¬ 
cisco,  Cal. 

The  Red  Cross  Magazine  —  American  Red  Cross, 
Washington,  D.  C. 


